Department of Surgery,Section of Surgical Oncology, Universityof Texas Health Science Center at SanAntonio, TX, USA.
J Clin Oncol. 2010 Jan 20;28(3):481-6. doi: 10.1200/JCO.2009.24.7734. Epub 2009 Dec 14.
Patients with thin melanoma (<or= 1.0 mm) and melanoma in situ (MIS) represent the majority of newly diagnosed melanoma. We estimated the impact of expert review of outside pathology material on the staging and thus treatment decisions affecting patients referred to a multidisciplinary clinic with early-stage melanoma.
We studied patients with a diagnosis of thin melanoma or MIS referred to H. Lee Moffitt Cancer Center from 2006 to 2009. After comparing the referring laboratory and in-house dermatopathologic interpretations, we calculated any differences in diagnosis and tumor staging and the potential impact of differences in diagnosis and staging on prognosis and surgical treatment using the National Comprehensive Cancer Network clinical guidelines.
The overall pathologic discordance rate in diagnosis was 4% (15 of 420 patients; 95% CI, 2% to 6%). The overall change in tumor staging rate was 24% (97 of 405 patients; 95% CI, 20% to 28%). Pathology review led to changes in surgical excision margins in 12% of patients (52 of 420 patients; 95% CI, 9% to 16%) and in the decision about whether to perform a sentinel lymph node biopsy in 16% of patients (67 of 420 patients; 95% CI, 13% to 20%). Key pathologic factors, particularly mitotic rate, were frequently missing from outside pathology reports.
Our data suggest that review of thin melanoma or MIS by an expert dermatopathologist results in frequent, clinically meaningful alterations in diagnosis, staging, prognosis, and surgical treatment. Referral of these patients to a multidisciplinary melanoma clinic is appropriate, and management of such patients should include review of the biopsy whenever feasible.
患有薄型黑色素瘤（≤1.0mm）和原位黑色素瘤（MIS）的患者占新诊断黑色素瘤患者的大多数。我们评估了对外部病理材料进行专家审查对分期的影响，从而影响了多学科诊所早期黑色素瘤患者的治疗决策。
我们研究了 2006 年至 2009 年期间从 H. Lee Moffitt 癌症中心转诊的薄型黑色素瘤或 MIS 患者。在比较了转诊实验室和内部皮肤科病理学家的解释后，我们计算了诊断和肿瘤分期方面的任何差异，并使用国家综合癌症网络临床指南计算了诊断和分期差异对预后和手术治疗的潜在影响。
总体病理诊断不一致率为 4%（420 例患者中有 15 例；95%置信区间，2%至 6%）。肿瘤分期改变率为 24%（405 例患者中有 97 例；95%置信区间，20%至 28%）。病理检查导致 12%（420 例患者中有 52 例；95%置信区间，9%至 16%）的患者手术切除边缘发生变化，导致 16%（420 例患者中有 67 例；95%置信区间，13%至 20%）的患者决定是否进行前哨淋巴结活检。关键的病理因素，特别是有丝分裂率，经常从外部病理报告中缺失。
我们的数据表明，由专家皮肤科病理学家对薄型黑色素瘤或 MIS 进行审查，可频繁且具有临床意义地改变诊断、分期、预后和手术治疗。将这些患者转介至多学科黑色素瘤诊所是合适的，此类患者的管理应包括在可行的情况下对活检进行审查。
